Left ventricular failure may be caused by:
- Cardiac infarction
- Aortic disease
- Mitral incompetence
- Essential hypertension.
The patient is severely breathless on exertion and has to sit up in bed to breathe, gasping for
breath. He or she may wake up suddenly and feel hot. The breathlessness gets progressively
worse until it is constant. There may also be a cough at night with watery-frothy sputum,
palpitations, giddiness, nausea, vomiting, diarrhoea and abdominal pain. The phenomenon of
"pulsus alternans" may be heard on the sphygmomanometer: at the upper limit only half the heart
beats come through but when the pressure is lowered by 10 mm or more all the beats become
audible. For example, at 180 mm the pulse rate may appear to be 50, whilst at 160 mm it is 100.
General Causes
Anaemia
Breathlessness on exertion is a feature of anaemia.
The causes of breathlessness are summarized in Table 3.2Table 3.2.
"Xiao" indicates a wheezing sound which may resemble that of whistling, snoring or sawing. It is
usually accompanied by breathlessness with an inability to breathe when lying down.
The "Prescriptions of the Golden Chest" by Dr Zhang Zhong Jing was the first book to refer to
wheezing: "For cough with a moor-hen sound in the throat, use Belamcanda-Ephedra
Decoction."1(101) The "moor-hen sound in the throat" is wheezing. In later times wheezing was
also variously described as "hidden Yin", "sip cough", "howling wheezing" and "snoring